Differential Diagnosis for ICH Mimicking STEMI

• Single most likely diagnosis
  • Acute Intracranial Hemorrhage (ICH): This is the most likely diagnosis because the presentation of ICH can sometimes mimic that of STEMI (ST-Elevation Myocardial Infarction), with symptoms such as sudden onset of severe headache, nausea, vomiting, and even chest pain due to increased intracranial pressure causing a vagal response.
• Other Likely diagnoses
  • Subarachnoid Hemorrhage (SAH): SAH can present with sudden, severe headache and may have associated symptoms that could be confused with STEMI, such as chest pain or electrocardiogram (ECG) changes due to the stress response.
  • Status Epilepticus: Prolonged seizure activity can lead to significant metabolic derangements and ECG changes that might mimic STEMI, and it can be precipitated by or occur concurrently with ICH.
• Do Not Miss diagnoses
  • Aortic Dissection: Although less common, aortic dissection can present with chest pain and ECG changes that mimic STEMI and can also lead to ICH if the dissection involves the carotid arteries.
  • Pulmonary Embolism (PE): A large PE can cause sudden onset of symptoms including chest pain and ECG changes, and it is crucial not to miss this diagnosis due to its high mortality rate if untreated.
  • Cardiac Tamponade: This condition, characterized by fluid accumulation in the pericardial sac, can lead to cardiac compression and mimic STEMI on ECG. It's a medical emergency requiring prompt intervention.
• Rare diagnoses
  • Cervical Artery Dissection: Dissection of the cervical arteries can lead to stroke or ICH and may present with symptoms that could be confused with STEMI, including severe headache and neck pain.
  • Pheochromocytoma: This rare tumor can cause episodic hypertension, leading to ICH, and its associated symptoms (e.g., palpitations, sweating) might be mistaken for STEMI.
  • Thyrotoxic Crisis: Although rare, thyrotoxic crisis can present with symptoms that overlap with STEMI, including chest pain and ECG changes, and can also lead to ICH due to severe hypertension.